Medicaid Work Rules Surprise States

The Host

New rules out this week from the Trump administration for implementing work requirements for adult Medicaid recipients surprised many state officials. The rules make it more difficult for states to determine who should be exempt from the requirements, including by stipulating that having a serious condition such as HIV or cancer does not automatically excuse an enrollee from having to engage in 80 hours per month of paid work, volunteering, or school attendance.

Meanwhile, a separate rule would give political appointees far more power over who gets health and science grant funding, and what political activities grant recipients can participate in. This would be a dramatic change — currently most decisions are made by career scientists and outside peer reviewers and based solely on scientific merit rather than whether they advance an administration’s political agenda.

This week’s panelists are Julie Rovner of KFF Health News, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Liz Essley Whyte of The Wall Street Journal.

Panelists

Among the takeaways from this week’s episode:

• The Medicaid work requirement was pitched as a massive money-saver for the federal government because, supporters argued, it will keep people who shouldn’t be eligible for the program from being on the rolls. But it is becoming clear that implementing the policy is going to cost states tens of millions of dollars in new hires, contracts, communication campaigns, and tech systems. State officials say this is coming when budget pressures are already high.
• The White House has advanced long-anticipated draft regulations designed to give political appointees the final word on federal research grants. The regulations, which have been close to the heart of Office and Management and Budget Director Russell Vought and were included in Project 2025, would empower the federal branch to pull back funding if political appointees find grantees doing work at odds with the president’s agenda.
• In a move that went somewhat unnoticed, President Donald Trump on Friday gave his official endorsement to a study by the Department of Health and Human Services that calls for cutting the number of vaccines recommended for every American child. It’s not clear what impact Trump’s action will have — the changes that Health and Human Services Secretary Robert F. Kennedy Jr. tried to make have been put on hold by federal courts.
• A final rule issued this past week for the No Surprises Act makes changes designed to improve communication between insurers and providers. The rule does not, however, get at what’s emerged as the law’s biggest problem: When disputes between doctors and insurers reach arbitration, doctors are the overwhelming winners. And it is costing millions. Fixing the underlying issues would probably require legislative attention.

Also this week, Rovner interviews KFF Health News reporter Lauren Sausser, who wrote the latest “Bill of the Month,” about a patient with a temporary memory problem and a less forgettable $59,000 hospital bill. If you have an outrageous or inscrutable medical bill you’d like to share with us, you can do that here.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: KFF Health News and The Associated Press’ “Festering Infections to Untreated Cancer: ICE Detainees Describe Medical Neglect Across US,” by Rae Ellen Bichell, Claire Galofaro, Maia Rosenfeld, Renuka Rayasam, Aaron Kessler, and Byron Tau.

Liz Essley Whyte: The Wall Street Journal’s “The Autism-Therapy Business Is Booming — And So Is the Billing Abuse,” by Christopher Weaver and Anna Wilde Mathews.

Alice Miranda Ollstein: The New York Times’ “The Return of Blaming and Shaming in Public Health,” by Simar Bajaj.

Margot Sanger-Katz: ProPublica’s “‘No One Is Watching’: How Trump Reversed Biden’s Crackdown on Gun Trafficking,” by Alec MacGillis and Ken B. Morales.

Also mentioned in this week’s podcast:

• Politico’s “States Balk at the High Price of Medicaid Work Requirements Amid Budget Crunch,” by Robert King and Alice Miranda Ollstein.
• The New York Times’ “Trump Administration Announces Stricter Rules for Medicaid Work Requirement,” by Margot Sanger-Katz and Sarah Kliff.
• The Washington Post’s “Courts May Deliver the Anti-Vaccine Movement’s Biggest Win,” by Lauren Weber.

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